San Francisco Chronicle - Wednesday, May 21, 2003
Cecile C.A. Balgos, Chronicle Foreign Service

Almost 20 years after the nation's first reported HIV infection, the number of HIV/AIDS cases is just 9,400 -- only 0.1 percent of people age 15 to 49, according to UNAIDS, the United Nations program that monitors the spread of the disease. In contrast, Burma, with about half the Philippines' population, has at least 400,000 people infected with the virus.

While UNAIDS' estimates are well regarded around the world, nobody knows exactly how many Filipinos actually have HIV/AIDS. The government puts the number as low as 1,810, while a former health minister said the true figure could be as high as 100,000.

But most AIDS experts agree on two things: The low number of reported infections is not the result of poor record-keeping and there is no clear reason for the nation's success in keeping the lethal virus at bay.

At an AIDS conference last year in Manila, President Gloria Macapagal Arroyo cited "high morality" as a major factor in the low infection rate.

"Local studies over the past 10 years show that Filipinos tend to start having sex later than in the United States, Europe and neighboring (Asian) countries," said Dr. Michael L. Tan, a medical anthropologist and an AIDS expert.

The surveys have shown that Filipinos typically have fewer sexual partners than do people in Asian countries with higher AIDS rates. Government statistics show that only 15 percent of heterosexual Filipino men frequent brothels, compared with 80 to 90 percent of their Thai counterparts.

Health experts also cite the low number of intravenous drug addicts. UNAIDS estimates that only 0.6 percent of those infected in this country acquired the disease by injecting drugs, compared to 38 percent in Vietnam.

But many health officials have warned their colleagues not to allow the low numbers to lull them into a state of complacency, arguing that all the ingredients of an epidemic exist here.

Dr. James Piad, a member of the Philippine National AIDS Council, the government advisory body for prevention and control, says the virus has an explosive potential.

Specifically, experts point to the millions of Filipinos who work overseas and are potential carriers of the virus each time they return home.

Filipinos have a long history of overseas migration, with the United States among the most popular destinations.

Today, an estimated 7.5 million Filipinos work in some 150 countries and as many as 2,500 leave the country daily. Dollar remittances from overseas make up almost 85 percent of the nation's gross foreign exchange earnings.

Once abroad, says Malu Marin, executive director of the nongovernmental organization Action for Health Initiatives, Filipinos "are able to reinvent their life. Basically, everybody turns a blind eye (to sexual encounters) and even encourages them."

AIDS activists say overseas workers often break vows of fidelity to their spouses to ease loneliness or simply become more sexually liberated far from society's shackles. When they return, they pass the virus on to spouses.

According the National Epidemiology Center, overseas workers comprise about 30 percent of all HIV/ AIDS cases.

Take Rudy, a seaman who often frequented prostitutes while on shore leave. Rudy, 46, who asked that his real name not be used, says his wife was surprised when he abruptly cut short his last contract and called her from Manila's international airport.

"She asked me, 'Did you bring any money?' " he recalled. "I told her, 'No, but I brought home a virus.' " Rudy says his wife only started talking to him again recently -- a year after he tested HIV-positive in Singapore.

Most infected Filipinos acquire HIV through sexual transmission -- 57 percent from heterosexual sex and 34 percent from homosexual contact, according to UNAIDS.

Health activists blame official apathy for the spread of the disease. After a much-lauded AIDS awareness campaign in the late 1980s and early '90s, the government has since passed the torch of AIDS education to nongovernmental organizations, which have fewer resources for continuing to spread the message.

As a result, studies show that many Filipinos believe the virus is most likely to hit Westerners and see no reason to take precautions, even when sleeping with multiple partners.

"Most Filipinos don't know anyone with AIDS on a personal basis, and this tends to create apathy," said Tan.

Moreover, the government has been leery of angering the Roman Catholic Church by promoting condom use. About 80 percent of the population is Catholic.

Condoms are unpopular with many men, and women are reluctant to ask their partners to use them, AIDS activists say. Consequently, the Philippines has one of the lowest condom usage rates in Asia. According to a 2000 study, two- thirds of sexually active males have never used condoms.

Under Filipino law, the government requires potential foreign workers to attend an HIV/AIDS seminar and to show proof of attendance before leaving the country. Rudy says a labor agency furnished him with a fake attendance certificate.

Rudy now shares his experiences as an activist for the Positive Action Foundation Philippines Inc., a nonprofit support group for those infected with HIV/AIDS that also educates Filipinos about the virus.

But he finds earning a living while keeping the virus in check a challenge. As a seaman, he earned a minimum monthly salary of $435, or more than two times the wage of a Manila office clerk. Now, he struggles to support his family on the meager pay of an AIDS activist and says the government has done nothing to help him with medical assistance or find a job.

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